| NPI | 1720571136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2022-0215) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018012258) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2024-03-13 |